Paediatric High Dependency Care in West, North and East Yorkshire

A 36 item, measurement tool to establish the volume of paediatric high dependency care (PHDC) activity was developed from inpatient episode data (n = 24,540) collected in 14 hospitals in West, North and East Yorkshire in 2005. The PHDC measurement tool was subsequently applied to the inpatient episode data (n = 24,540) to estimate the amount and location of PHDC by hospital ward type (District General Hospitals, (DGHs), paediatric intensive care units (PICUs), specialist hospital wards and a DGH with specialist paediatric facilities). A total of 9,077 episodes of PHDC for 1,763 children were measured. The majority (55%) of children receiving PHDC were male and 25% were infants (aged 29 days to 1 year). The specialist hospital wards provided the majority (42%) of episodes of PHDC.

Clinical staffing data to determine the number and level of skills of doctors and nurses providing care was also collected in 2005. A total of 7.5% of shifts were without a Registered Children’s Nurse (RN (Ch)). A further 4.5% of shifts worked with only one RN (Ch), of which, 76% was for the period of the night shift. Over one-quarter (28%) of all shifts were without a nurse with valid advanced paediatric life support (APLS) skills, and 43% of all doctors were without valid APLS skills. When the skills of nurses were matched to the dependency needs of children a disproportionate number of qualified nurses to children was most noticeable at night on all hospital ward types, excluding the PICUs.

This study is unique, firstly, in its ability to quantify PHDC in the Yorkshire region, and, secondly, to match the dependency needs of children to the available skills of the workforce. This information has provided important information to assist with the organisation, planning and delivery of PHDC in Yorkshire.